- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,263.00 / $6,014.00 / $12,464.00
| Facility | | $3,263.00 | $6,014.00 | $12,464.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,361.69 / $12,326.53 / $55,752.34
| Facility | | $2,361.69 | $12,326.53 | $55,752.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,918.11 / $3,918.11 / $3,918.11
| Facility | | $3,918.11 | $3,918.11 | $3,918.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $2,500.00 / $2,767.50
| Facility | | $500.00 | $2,500.00 | $2,767.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,651.51 / $4,073.68 / $5,975.11
| Professional | | $2,651.51 | $4,073.68 | $5,975.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,303.00 / $10,133.00 / $20,037.00
| Facility | | $2,303.00 | $10,133.00 | $20,037.00 |